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Is systolic blood pressure all that matters? No

BMJ 2009; 339 doi: (Published 10 July 2009) Cite this as: BMJ 2009;339:b2669
  1. Eoin O’Brien, professor of molecular pharmacology
  1. 1Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
  1. eobrien{at}

    Peter Sever (doi:10.1136/bmj.b2665) argues that abandoning diastolic measurements will improve control of blood pressure, but Eoin O’Brien thinks that we should change the method of measurement instead

    Since Riva-Rocci and Korotkoff gave us the technique for measuring blood pressure over a century ago, we have landed men on the moon, encircled Mars, invented the automobile and aeroplane, and most importantly revolutionised the technology of science with the microchip. Why, we might ask, has medicine ignored scientific evidence for so long and perpetuated a grossly inaccurate measurement technique in both clinical practice and hypertension research?1 And now we have a call from eminent clinical scientists to modify the technique by abandoning measurement of diastolic blood pressure in people over 50 years old.

    In fairness there would be an attraction to the argument if we were dependent solely on conventional measurement of blood pressure since the technique is grossly misleading. Firstly, it creates the phenomenon of white coat hypertension, which affects as many as 20% of patients with hypertension diagnosed by conventional measurement.2 Secondly, it …

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